Pelvic Floor Dysfunction in Men

The Pelvic Floor is a Complex Multifunctional Structure

It supports the urinary, fecal, sexual and reproductive functions and pelvic statics.

The symptoms caused by pelvic floor dysfunction often affect the quality of life of those who are afflicted, worsening significantly more aspects of daily life.

In fact, in addition to providing support to the pelvic organs, the deep floor muscles support urinary continence and intestinal emptying whereas the superficial floor muscles are involved in the mechanism of erection and ejaculation.

Chronic Pelvic Pain Syndrome

Millions of men suffer from pelvic pain and related dysfunction annually. While discomfort and pain are defining characteristics, men can also experience associated sexual and urinary problems. For many years the prostate was wrongly assumed to be the source of the pain and dysfunction

The vast majority of cases are not caused by the prostate gland, and are therefore more accurately called Chronic Pelvic Pain Syndrome (CPPS) rather than Chronic Prostatitis (CP).

P/CPPS is a condition characterized by discomfort and pain in the pelvic area, with or without associated urinary and sexual symptoms. It is surprisingly common, affecting 5 to 10 percent of the male population.

Discomfort and pain are the primary symptoms of CP/CPPS, which can affect any or all of the following areas: the pelvic floor, perineum, rectum, coccyx (tail bone), prostate, penis, testicles/scrotum, groin, thighs, lower abdomen, and low back. Symptoms can be intermittent or constant, and wax and wane over time.

Physical trauma or strain are certainly possible causes. A much more common mechanism, however, involves mental stress, emotional challenges, and past experience becoming embedded in the pelvic floor muscles in the form of tightness and rigidity.

Another mechanism to consider is the phenomenon of referred pain. All muscles, including those in and around the pelvic floor, have the potential to develop trigger points.

A specific trigger point in the abdominals, for example, can refer pain to the testicle on the same side; the Adductor Magnus muscle of the inner thigh can refer pain deep within the pelvis. The pelvic floor muscles themselves can refer pain to the genitals, perineum, anus/rectum, or coccyx (tail bone).

Complications of Prostatectomy

A radical prostatectomy is an operation to remove the prostate gland and some of the tissue around it. It is done to remove prostate cancer. This operation may be done by open surgery. Or it may be done by laparoscopic surgery through small incisions.

Laparoscopic surgery may be done by hand. But some doctors now do it by guiding robotic arms that hold the surgery tools. This is called robot-assisted prostatectomy.

Erection problems are one of the serious side effects of radical prostatectomy. The nerves that control a man's ability to have an erection lie next to the prostate gland. They often are damaged or removed during surgery. Sometimes these nerves can be spared during surgery to preserve erections.

About half of men are able to regain some of their ability to have erections. But this takes time. It can take as little as 3 months. But for most men, it will be 6 months to a year.

Recovery depends on:

  • Whether the man was able to have an erection before surgery.
  • How the surgery affected the nerves that control erections.
  • How old the man was at the time of surgery.

Urinary incontinence: up to half of all men who have a radical prostatectomy develop urinary incontinence, ranging from a need to wear urinary incontinence pads to occasional dribbling.

To remove the prostate, the surgeon must cut the urethra and later reconnect it to the bladder. Evidence shows that the greater the surgeon's experience and skill in making this reconnection, the lower the rate of incontinence. If urinary leakage continues longer than 1 year, you may need treatment for incontinence after prostatectomy.

Erectile Dysfunction

Erectile Dysfunction (ED) is the inability to get or keep an erection firm enough to have sexual intercourse. It’s also sometimes referred to as impotence.

Occasional ED isn’t uncommon. Many men experience it during times of stress. Frequent ED can be a sign of health problems that need treatment. It can also be a sign of emotional or relationship difficulties that may need to be addressed by a professional.

Not all male sexual problems are caused by ED. Other types of male sexual dysfunction include:

  • Premature ejaculation
  • Delayed or absent ejaculation
  • Lack of interest in sex

The symptoms of ED are: trouble in getting an erection; difficulty maintaining an erection during sexual activities; reduced interest in sex.

Other sexual disorders related to ED include: premature ejaculation; delayed ejaculation; anorgasmia, which is the inability to achieve orgasm after ample stimulation.

There are many possible causes for ED, and they can include both emotional and physical disorders. Some common causes are: cardiovascular disease; diabetes ; hypertension; damage from cancer or surgery ; obesity or being overweight ; increased age; anxiety.